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One third of doctors 'would consider assisted death' for dementia patients

In the Netherlands, more than 85% of doctors say they would consider helping a patient die, with 1 in 3 saying they would consider it if a patient were suffering from early dementia or mental illness. This is according to a new study published in the Journal of Medical Ethics that surveyed almost 1,500 Dutch doctors on their attitudes toward euthanasia and physician-assisted dying.

Around 86% of Dutch doctors said they would consider helping a patient to die, and 60% of respondents said they had helped a patient to die, with almost half reporting that they had done so within the past 12 months.

Back in 2002, the Netherlands became the first nation to legalize euthanasia and physician-assisted suicide in specific circumstances.

Under the Termination of Life Request and Assisted Suicide (Review Procedures) Act, physicians in the Netherlands are not prosecuted for euthanasia (administering lethal drugs to a patient) or physician-assisted suicide (providing a patient with legal drugs) as long as they follow certain criteria for due care.

For example, the criteria states that the patient must have the "presence of unbearable suffering
without prospect of improvement," the physician must have received a "voluntary and well-considered" request for euthanasia or physician-assisted suicide from the patient, and there must be an absence of reasonable treatment alternatives.

Patients do not have a "right to euthanasia," meaning a physician is able to reject a patient's request - a topic that has caused much debate in the Netherlands.

According to the researchers of this latest study, led by Dr. Eva Elizabeth Bolt of the VU University Medical Center in Amsterdam, the Netherlands, the country's media have reported that doctors have refused some patients' requests for assisted death based on their personal beliefs rather than their legal obligations.

"These patients had psychiatric disease, dementia or were 'tired of living' (in the absence of severe disease)," the authors explain. "The main question debated is whether [euthanasia and physician-assisted death] is legally and ethically acceptable in patients with these conditions and, if so, whether physicians should be willing to provide it."

According to the researchers, only a small proportion of requests for euthanasia or physician-assisted deaths are from patients who have a mental illness, dementia or are tired of living; most requests come from patients with cancer or another physical disease.

For their study, Dr. Bolt and her team set out to determine what doctors in the Netherlands thought about euthanasia and physician-assisted suicide, and under what circumstances they would engage in either practice.

The team surveyed 2,269 Dutch general practitioners, elderly care physicians and clinical specialists.

The doctors were asked whether they had ever helped a patient to die and for what reasons: cancer, another form of severe physical illness, mental illness, early or advanced dementia, or tired of living with or without severe physical illness.

Doctors who had not helped a patient to die were asked if they would consider it and under what circumstances they would do so.

Of the 1,456 doctors who completed the survey, 86% said they would consider helping a patient to die, and 60% of respondents said they had helped a patient to die, with almost half of these reporting that they had done so within the past 12 months.

Fast facts about euthanasia

Euthanasia comes from the Greek word for "good death"

Euthanasia is illegal in the US, but physician-assisted suicide is legal Washington, Oregon and Vermont and is currently being debated in Montana

The debate continues over whether euthanasia should be legalized in the US. While some people believe it is down to a patient to have the choice to die with dignity, others believe the practice is unethical.

One or more patient requests for euthanasia or physician-assisted dying had been received by 3 in every 4 doctors surveyed. For general practitioners alone, 9 in 10 said they had received such requests.

The team found that doctors' attitudes toward euthanasia and physician-assisted suicide varied by patient condition. Around 85% would consider helping a patient die if they had cancer or another physical disease.

In addition, they found that 34% of doctors would help a patient with a mental illness die, while 4 in 10 said they would help a patient with early stage dementia to die. Interestingly, if a patient was in the late stages of dementia, only 1 in 3 doctors said they would help them die, even if the patient held an advance written directive for euthanasia.

Around 1 in 4 doctors said they would help a patient with a severe medical condition die if they were tired of living, but in the absence of a severe medical condition, less than 1 in 5 said they would help the patient die.

More than half of the doctors said they had helped a patient with cancer die, while a third said they had helped a patient with another severe physical disease to die. Only 7% said they had helped a patient die in the absence of cancer or another severe physical condition.

Based on their findings, the researchers say it is clear that the cause of suffering in a patient is a "decisive factor" for doctors when it comes to patient requests for euthanasia or physician-assisted suicide. They add:

"Most Dutch physicians can conceive of performing [euthanasia or physician-assisted suicide] in patients suffering from cancer or another physical disease. However, in patients suffering from psychiatric disease, dementia or being tired of living, opinions differ.

To prevent disagreement and disappointment, it is important that a patient with a future wish for [euthanasia or physician-assisted suicide] discusses this with their physician in time and that the physician is clear about their standpoint on the matter."

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